International Multicenter Study of Clinical Outcomes of Sinonasal Melanoma Shows Survival Benefit for Patients Treated with Immune Checkpoint Inhibitors and Potential Improvements to the Current TNM Staging System

Matt Lechner, Yoko Takahashi, Mario Turri-Zanoni, Marco Ferrari, Jacklyn Liu, Nicholas Counsell, Davide Mattavelli, Vittorio Rampinelli, William Vermi, Davide Lombardi, Rami Saade, Ki Wan Park, Volker H. Schartinger, Alessandro Franchi, Carla Facco, Fausto Sessa, Simonetta Battocchio, Tim R. Fenton, Francis M. Vaz, Paul O'FlynnDavid Howard, Paul Stimpson, Simon Wang, S. Alam Hannan, Samit Unadkat, Jonathan Hughes, Raghav Dwivedi, Cillian T. Forde, Premjit Randhawa, Simon Gane, Jonathan Joseph, Peter J. Andrews, Manas Dave, Jason C. Fleming, David Thomson, Tianyu Zhu, Andrew Teschendorff, Gary Royle, Christopher Steele, Joaquin E. Jimenez, Jan Laco, Eric W. Wang, Carl Snyderman, Peter D. Lacy, Robbie Woods, James P. O'Neill, Anirudh Saraswathula, Raman Preet Kaur, Tianna Zhao, Murugappan Ramanathan, Gary L. Gallia, Nyall R. London, Quynh Thu Le, Robert B. West, Zara M. Patel, Jayakar V. Nayak, Peter H. Hwang, Mario Hermsen, Jose Llorente, Fabio Facchetti, Piero Nicolai, Paolo Bossi, Paolo Castelnuovo, Amrita Jay, Dawn Carnell, Martin D. Forster, Diana M. Bell, Valerie J. Lund, Ehab Y. Hanna

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives  Sinonasal mucosal melanoma (SNMM) is an extremely rare and challenging sinonasal malignancy with a poor prognosis. Standard treatment involves complete surgical resection, but the role of adjuvant therapy remains unclear. Crucially, our understanding of its clinical presentation, course, and optimal treatment remains limited, and few advancements in improving its management have been made in the recent past. Methods  We conducted an international multicenter retrospective analysis of 505 SNMM cases from 11 institutions across the United States, United Kingdom, Ireland, and continental Europe. Data on clinical presentation, diagnosis, treatment, and clinical outcomes were assessed. Results  One-, three-, and five-year recurrence-free and overall survival were 61.4, 30.6, and 22.0%, and 77.6, 49.2, and 38.3%, respectively. Compared with disease confined to the nasal cavity, sinus involvement confers significantly worse survival; based on this, further stratifying the T3 stage was highly prognostic (p < 0.001) with implications for a potential modification to the current TNM staging system. There was a statistically significant survival benefit for patients who received adjuvant radiotherapy, compared with those who underwent surgery alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI]: 0.57-0.96, p = 0.021). Immune checkpoint blockade for the management of recurrent or persistent disease, with or without distant metastasis, conferred longer survival (HR = 0.50, 95% CI: 0.25-1.00, p = 0.036). Conclusions  We present findings from the largest cohort of SNMM reported to date. We demonstrate the potential utility of further stratifying the T3 stage by sinus involvement and present promising data on the benefit of immune checkpoint inhibitors for recurrent, persistent, or metastatic disease with implications for future clinical trials in this field.

Original languageEnglish (US)
Pages (from-to)307-319
Number of pages13
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume84
Issue number4
DOIs
StatePublished - Jan 22 2022

Keywords

  • TNM
  • immune checkpoint blockade
  • immune checkpoint inhibitors ipilimumab
  • immunotherapy
  • sinonasal mucosal melanoma

ASJC Scopus subject areas

  • Clinical Neurology

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